Obamacare extends health benefits to 30 million. But what if people don’t sign up?

November 7, 2012

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Millions of Americans will be eligible for subsidized health insurance under the Affordable Care Act, starting in 2014.

Most of those people, however, have absolutely no idea that they're qualified to sign up.

"More than three quarters of the uninsured who will be eligible for coverage, either in Medicaid or the exchange, are unaware of those new opportunities," says Ron Pollack. He chairs the board of Enroll America, a nonprofit aimed at ensuring that Americans do get coverage.

Enroll America has been around for about a year now. It's meant to be a temporary organization, solely devoted to ensuring that people know about the benefits coming online in 2014.

The CBO estimates that the health reform law will cover 30 million more Americans in 2022. But it also predicts that 30 million Americans will remain uninsured. Some will be illegal immigrants, who aren’t eligible for the reform law’s insurance subsidies. About 6 million are expected to live in states that do not participate in the Medicaid expansion.

That still leaves millions of Americans eligible for benefits but not enrolled. The CBO, for example, expects that nearly 6 million of those newly-eligible for Medicaid just won’t sign up for the program. They already have some reason to be skeptical: The health law's High Risk Insurance Plans, meant to be a bridge to 2014 for those with preexisting conditions, have seen lackluster enrollment.

This leaves open a pretty wide playing field for a group like Enroll America. If it does its job really well, the number of Americans who go way past 30 million. If it doesn’t, the number who sign up could fail to meet CBO projections.

To boost enrollment numbers, Enroll America has partnered with 55 other organizations ranging from insurers to hospitals to drug store chains. All are looking to boost the number of Americans who will take advantage of subsidized insurance or Medicaid eligibility.

"I think it's really clear from all the research we've seen so far that the vast majority of people who will need to enroll in coverage don't even know it's available or coming," says Enroll America Executive Director Rachel Klein. 

Now that the Affordable Care Act is here to stay, Enroll America is about to kick into high gear: They have a little over a year to educate millions of Americans about the new benefits that they'll have access to, and how to get them.

Enroll America has contracted with two research firms to figure out how best to communicate with potential beneficiaries, what might be the best messages and who would be best to deliver them. The group recently wrapped up a national survey on questions like these, and is now sifting through the results.

They will start next week with focus groups in three cities aimed at answering these same kind of questions. "The focus groups will drill down on key demographic groups that can be disproportionately helped by the law," Pollack says. 

In the coming months, they expect to start convening other nonprofits, as well as officials from Health and Human Services, to share research on best messaging strategies. 

Pollack also hopes that  with the Affordable Care Act's fate secured, fundraising for his group might become a little easier, too.

"It has not been the easiest thing when the fate of the law is so uncertain," Pollack said, noting that fundraising has been in the low millions. "We have a drop in the bucket compared to what we'll need. If there's going to be an advertising campaign, we're talking about $10 millions, if not another digit."

While they're not "anywhere" close to that, Pollack says, "It's a bit easier to go to places after the reelection." 

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Dylan Matthews | November 7, 2012